Douglas Ingram
Analyst · Goldman Sachs. Your line is open.
Again, on the first question, I'm not a 100% confident I understand the question. Let me be very clear, the standard for confirmation of an accelerated approval is looking at the totality of evidence and determining whether the benefits of that therapy have been confirmed by the entire data set, not just the confirmatory data, but all of the surrounding evidence that would exist, including other studies. And I would strongly argue that not only EMBARK, but all of the supporting evidence as well, has strongly confirmed the benefits of this therapy. So I think we're in very good shape there. The focus of our review with this division is going to be on the breadth of the expansion of this label. That, I am quite confident, is going to be the review focus. And as relates to that, as you know, our strong view is that having confirmed these results, having confirmed them across patients and looking at the totality of these evidence and looking at the forest plot as an example, and looking at the statistical analysis of the forest plot adjusted for multiplicities, it is quite clear that this therapy is arresting the decline in these patients and deserves to be made available to the patients without limitation to age or artificial restrictions around angulation. As it relates to payers, this is additional evidence in our armamentarium with payers. Things have gone very well. Dallan and his team, Medical Affairs, our commercial, our field force, access to reimbursement and the like have just done a fabulous job supporting the launch of the ELEVIDYS. And I hope everyone will agree with me that it shows in our performance this quarter and this bolsters the discussion that the team can have. Now we can give as an example. We now have a really powerful metric that it's compelling on the speed with which one you put a kit on therapy. So as I will remind you on the time to rise, not only is the P value, I think, 0.002, if I am not mistaken -- but in time to rise is the single greatest prognosticator of loss of ambulation and a rise time above 5 seconds, as we've talked about often and is in the literature robustly is the single greatest predictor of early loss of ambulation. And EMBARK has shown that using ELEVIDYS reduces the odds of that occurring in a 52-week period by over 90%. So this provides an additional compelling point with payers who, frankly so far have done a really good job of providing access. This provides additional evidence that it really is important to get kids on this therapy as soon as possible. And I would argue looking forward to label expansion and is a compelling argument for why this therapy should be -- this label should be expanded as soon as possible as well. So everyone has access to it as well.